What is DHEA
DHEA (dehydroepiandrosterone) is one of the hormones produced by the adrenal glands. After being secreted by the adrenal glands, it circulates in the bloodstream as DHEA-sulfate (DHEAS) and is converted as needed into other hormones. Where is DHEA found? DHEA is produced by the adrenal glands. A synthetic form of this hormone is also available as a supplement in tablet, capsule, liquid, and sublingual form. Some products claim to contain “natural” DHEA precursors from wild yam. However, the body cannot convert these substances into DHEA1 (although a series of reactions in a laboratory can make the conversion).
Who is likely to be deficient in DHEA?
Meaningful levels of DHEA do not appear in food, and therefore dietary deficiency does not exist. Some people, however, may not synthesize enough DHEA. DHEA levels peak in early adulthood and then start a lifelong descent. By the age of 60, DHEA levels are only about 5–15% of what they were at their peak at younger ages.2 Whether the lower level associated with age represents a deficiency or a normal part of aging that should not be tampered with remains unknown.
People with true adrenal insufficiency (i.e., Addison’s Disease; not the hypothetical adrenal “fatigue” or “burnout” that is sometimes incorrectly referred to as “insufficiency”) have below normal levels of DHEA. When women with adrenal insufficiency were treated with 50 mg of DHEA every morning for three or four months, their DHEA and DHEAS levels returned to normal, with a simultaneous improvement in well-being and sexuality.3 4
Some studies have reported lower DHEA levels in groups of depressed patients.5 6 However, in one trial, severely depressed people were reported to show increases in blood levels of DHEA.7 Despite these contradictory findings, a few clinical trials suggest that at least some people who are depressed may benefit from DHEA supplementation.
People with multi-infarct dementia (deterioration of mental functions resulting from multiple small strokes) may have lower than normal DHEAS levels, according to a preliminary trial.8 In this trial, intravenous injection of 200 mg per day of DHEAS for four weeks increased DHEAS levels and improved some aspects of mental function and performance of daily activities.
People infected with HIV9 and those with insulin-dependent diabetes,10congestive heart failure,11 multiple sclerosis, 12 asthma,13 14 chronic fatigue syndrome,15 16 rheumatoid arthritis,17 18 19 osteoporosis, and a host of other conditions have been reported to have low levels of DHEA in most,20 but not all, studies.21 22 In most cases, the meaning of this apparent deficiency is not well understood.
Men under 60 years of age with erectile dysfunction have been found to have lower DHEAS levels than men without the condition.23
Most,24 25 26 27 but not all, 28 29 studies have found that people with Alzheimer’s disease have lower blood DHEAS levels than do people without the condition.
How much DHEA is usually taken?
Most people do not need to supplement DHEA. The question of who should take this hormone remains controversial. Some experts believe that daily intakes of 5–15 mg of DHEA for women and 10–30 mg for men are appropriate amounts for people with deficient blood levels of DHEA or DHEAS.30 While a few researchers suggest supplementation with as much as 50 mg per day in postmenopausal women,31 others consider this level excessive.32 People should consult a doctor to have DHEA levels monitored before and during supplementation. Healthy people with normal blood levels of DHEA or DHEAS should not take this hormone until more is known about its effects. However, some doctors recommend DHEA supplementation for selected people with depression, autoimmune diseases, or other problems, even if their blood levels are normal.
People with systemic lupus erythematosus (SLE) have been shown to improve after taking 100–200 mg per day of DHEA. Such large amounts should never be taken without medical supervision.
Discrepancies between label claims and actual DHEA content of DHEA supplements have been reported.33Regrettably, the authors of this report failed to identify which brands were properly labeled and which were not.
Are there any side effects of DHEA?
Experts have concerns about the use of DHEA, particularly because long-term safety data do not exist.
Side effects at high intakes (50–200 mg per day) appear to be acne (in over 50% of people), increased facial hair (18%), and increased perspiration (8%). In a preliminary trial, DHEA was also reported to induce less common side effects, including breast tenderness, weight gain, mood alteration, headache, oily skin, and menstrual irregularity in some people.34 Since this trial was not controlled, some of these less common “side effects” might have occurred even with a placebo. A case of mania has been reported in an older man who took 200–300 mg of DHEA per day for six months.35 However, in that case report, other causes of mania could not be ruled out.
Significant increases in testosterone levels in both men and women have been reported in some trials.36 37 Other reports have found this change in women but not in men.38 An increase in testosterone might increase the risk of several cancers, and high amounts of DHEA have caused cancer in animals.39 40 Moreover, a possible link between higher DHEA levels and risks of prostate cancer in humans has been reported.41 At least one person with prostate cancer has been reported to have had a worsening of his cancer, despite feeling better, while taking very high amounts (up to 700 mg per day) of DHEA.42
While younger women with breast cancer may have low levels of DHEA, postmenopausal women with breast cancer appear to have high levels of DHEA, which has researchers concerned.43 44 Most,45 46 47 48 49 but not all, studies50 51 52 have found that as DHEA blood levels increase, so does the risk of breast cancer.
Supplementation with high levels of DHEA (100 mg per day) has adversely affected other indicators of cancer risk in both women and men.53 54 Elevated DHEA levels have been reported to be associated with both higher,55 and lower risk for ovarian cancer.56 The reason for this discrepancy is unknown.
The lack of knowledge about how DHEA supplementation might affect cancer risks provides a reason for caution. Until more is known, people with breast or prostate cancer or a family history of these conditions should avoid supplementing with DHEA.
Although anticancer effects of DHEA have also been reported,57 they involve trials using animals that do not process DHEA the way humans do. Therefore, these positive effects may have no relevance for people.
Some doctors recommend that people taking DHEA have liver enzymes measured routinely. Anecdotes of DHEA supplementation (of at least 25 mg per day) leading to heart arrhythmias have appeared.58
The relationship between DHEA, blood pressure, and heart disease is poorly understood. Increased blood levels of DHEAS have been associated with increased blood pressure59 and other cardiovascular risk factors in some,60 but not all,61 studies. One study found that people with hypertension had significantly decreased blood levels of DHEA.62 Until clinical trials clear up these inconsistencies and confirm its safety, people with hypertension should avoid using DHEA, except under the close supervision of a doctor.
At only 25 mg per day, DHEA has lowered HDL cholesterol while increasing insulin-like growth factor (IGF).63Decreasing HDL could increase the risk of heart disease. Increasing IGF might increase the risk of breast cancer.
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